Choroidal neovascularization associated with focal choroidal excavation – Accepted Manuscript

Abstract: Purpose: To describe the clinical and imaging characteristics of choroidal neovascularization (CNV) accompanied by focal choroidal excavation.Design: Retrospective, interventional case series.Methods: The medical records of 16 patients (16 eyes) were reviewed. Imaging findings including fluorescein angiography (FA), indocyanine green angiography and spectral-domain optical coherence tomography (SD-OCT) were analyzed.Results: CNV complexes were primarily located beneath the retinal pigment epithelium (type 1 CNV) in 9 eyes, and in the subneurosensory retinal space (type 2 CNV) in 7 eyes, as assessed by SD-OCT. Seven of 8 patients over 50 years old had type 1 CNV, and 6 of 8 patients under 50 had type 2 lesions. All 7 eyes with type 2 CNV exhibited classic CNV on FA. Additionally, 7 of 9 eyes with type 1 CNV had the classic pattern, and in these eyes, the CNV complexes were confined to the concavity of choroidal excavation. In 15 patients treated by antivascular endothelial growth factor (anti-VEGF) injections, the mean best-corrected visual acuity improved from 20/44 to 20/26 with a mean of 3.7 injections during a mean follow-up period of 14.5 months.Conclusions: The CNV growth pattern and extent seems to be determined by the degree of damage to retinal pigment epithelium/Bruch’s membrane complex resulting from choroidal excavation, as well as age. Neovascular complexes tend to be located within the boundary of choroidal excavation and are revealed as classic patterns on FA, even in type 1 CNV. Anti-VEGF was notably effective for treating these lesions with a low rate of recurrence.